<html>
	<head>
		<meta http-equiv="Content-Type" content="text/html; charset=iso-8859-1">
		<title>%title%</title>
		<style type="text/css">
		<!--
			.style1 {font-family: Verdana, Arial, Helvetica, sans-serif}
			.style2 {font-family: Verdana, Arial, Helvetica, sans-serif; font-size: small; }
			.style4 {font-family: Verdana, Arial, Helvetica, sans-serif; font-size: small; font-weight: bold; }
			.style5 {font-family: Verdana, Arial, Helvetica, sans-serif; font-size: large; }
			.style6 {
	font-family: "Times New Roman", Times, serif;
	font-size: x-small;
	font-weight: bold;
	font-style: italic;
}
		-->
		</style>
	</head>

	<body>
		<table width="800" border="1" class="style2">
		  
		  <tr>
		    <th colspan="5" bgcolor="#999999" scope="row"><span class="style5">Faculty Evaluation By Students - %clerkship% </span></th>
		  </tr>
		  <tr>
		    <th colspan="5" bgcolor="#999999" scope="row"><span class="style1">Class of %year% (N=%n%/24), %dates%</span></th>
		  </tr>
		  <tr>
		    <th colspan="5" bgcolor="#999999" scope="row"><span class="style1">1-Unsatisfactory____2-Satisfactory___3-Good___4-Very Good___5-Excellent</span></th>
		  </tr>
		  
		  <tr>
		    <th width="160" bgcolor="#999999" scope="row"><h4 class="style2">&nbsp;</h4></th>
		    <td width="777" bgcolor="#999999"><div align="center">
		      <h4>Questions</h4>
		    </div></td>
		    <td width="77" bgcolor="#999999"><h4 align="center">Highest Mean </h4></td>
		    <td width="108" bgcolor="#999999"><h4>%teacher%</h4></td>
		    <td width="83" bgcolor="#999999"><h4 align="center">Lowest Mean </h4></td>
		  </tr>
		  <tr>
		    <th rowspan="2" bgcolor="#999999" class="style4" scope="row"><h4>Medical Expert </h4></th>
		    <td>(1) Builds basic concepts and stimulates me to learn independently</td>
		    <td>%h_me_1%</td>
		    <td>%a_me_1%</td>
		    <td>%l_me_1%</td>
		  </tr>
		  <tr>
		    <td>(2) Supervises well the teaching where applicable</td>
		    <td>%h_me_2%</td>
		    <td>%a_me_2%</td>
		    <td>%l_me_2%</td>
		  </tr>
		  <tr>
		    <th rowspan="5" bgcolor="#999999" class="style4" scope="row"><h4><span class="style1"></span><span class="style1"></span><span class="style1"></span><span class="style1"></span><span class="style1"></span>Communicator</h4></th>
		    <td bgcolor="#FFFFFF" class="navText">(3) Serves as a role model of effective and compassionate communication with patients and families </td>
		    <td>%h_cm_1%</td>
		    <td>%a_cm_1%</td>
		    <td>%l_cm_1%</td>
		  </tr>
		  <tr>
		    <td bgcolor="#FFFFFF" class="navText">(4) Communicates effectively with students and peers </td>
		    <td>%h_cm_2%</td>
		    <td>%a_cm_2%</td>
		    <td>%l_cm_2%</td>
		  </tr>
		  <tr>
		    <td bgcolor="#FFFFFF" class="navText">(5) Provides effective and timely feedback </td>
		    <td>%h_cm_3%</td>
		    <td>%a_cm_3%</td>
		    <td>%l_cm_3%</td>
		  </tr>
		  <tr>
		    <td bgcolor="#FFFFFF" class="navText">(6) Adjusts teaching to diverse settings(e.g., Interview, diagnostic, examination, procedural, lab) </td>
		    <td>%h_cm_4%</td>
		    <td>%a_cm_4%</td>
		    <td>%l_cm_4%</td>
		  </tr>
		  <tr>
		    <td bgcolor="#FFFFFF" class="navText">(7) Responds encouragingly to students queries </td>
		    <td>%h_cm_5%</td>
		    <td>%a_cm_5%</td>
		    <td>%l_cm_5%</td>
		  </tr>
		  <tr>
		    <th rowspan="2" bgcolor="#999999" class="style4" scope="row"><h4><span class="style1"></span><span class="style1"></span>Collaborator</h4></th>
		    <td bgcolor="#FFFFFF" class="navText">(8) Promotes team work in small groups and/or patients care teams</td>
		    <td>%h_cl_1%</td>
		    <td>%a_cl_1%</td>
		    <td>%l_cl_1%</td>
		  </tr>
		  <tr>
		    <td bgcolor="#FFFFFF" class="navText">(9) Demonstrates respectful interaction with trainees/other health professionals/other physicians in clinical and/or class room situations </td>
		    <td>%h_cl_2%</td>
		    <td>%a_cl_2%</td>
		    <td>%l_cl_2%</td>
		  </tr>
		  <tr>
		    <th rowspan="2" bgcolor="#999999" class="style4" scope="row"><h4><span class="style1"></span><span class="style1">Manager</span></h4></th>
		    <td bgcolor="#FFFFFF" class="navText">(10) Role models time managment and punctuality </td>
		    <td>%h_m_1%</td>
		    <td>%a_m_1%</td>
		    <td>%l_m_1%</td>
		  </tr>
		  <tr>
		    <td bgcolor="#FFFFFF" class="navText">(11) Allows me autonomy appropriate to my level/experience/competence</td>
		    <td>%h_m_2%</td>
		    <td>%a_m_2%</td>
		    <td>%l_m_2%</td>
		  </tr>
		  <tr>
		    <th rowspan="2" bgcolor="#999999" class="style4" scope="row"><h4><span class="style1"></span><span class="style1">Health Advocate </span></h4></th>
		    <td bgcolor="#FFFFFF" class="navText">(12) Advocates health promotion and prevention of disease </td>
		    <td>%h_ha_1%</td>
		    <td>%a_ha_1%</td>
		    <td>%l_ha_1%</td>
		  </tr>
		  <tr>
		    <td bgcolor="#FFFFFF" class="navText">(13) Acts as an advocate for students and patients(speaks for their rights) </td>
		    <td>%h_ha_2%</td>
		    <td>%a_ha_2%</td>
		    <td>%l_ha_2%</td>
		  </tr>
		  <tr>
		    <th rowspan="4" bgcolor="#999999" class="style4" scope="row"><h4><span class="style1"></span><span class="style1"></span><span class="style1"></span><span class="style1">Scholar</span></h4></th>
		    <td bgcolor="#FFFFFF" class="navText">(14) Incorporates evidence into teaching and patient care and teaches diagnostic and patient management skills </td>
		    <td>%h_s_1%</td>
		    <td>%a_s_1%</td>
		    <td>%l_s_1%</td>
		  </tr>
		  <tr>
		    <td bgcolor="#FFFFFF" class="navText">(15) Establishes good learning environtment through interaction </td>
		    <td>%h_s_2%</td>
		    <td>%a_s_2%</td>
		    <td>%l_s_2%</td>
		  </tr>
		  <tr>
		    <td bgcolor="#FFFFFF" class="navText">(16) Adjusts teaching to my needs (experience, competence, residency program, intersts) </td>
		    <td>%h_s_3%</td>
		    <td>%a_s_3%</td>
		    <td>%l_s_3%</td>
		  </tr>
		  <tr>
		    <td bgcolor="#FFFFFF" class="navText">(17)Asks questions that promote learning(clarifications, probes, reflective questions) </td>
		    <td>%h_s_4%</td>
		    <td>%a_s_4%</td>
		    <td>%l_s_4%</td>
		  </tr>
		  <tr>
		    <th rowspan="3" bgcolor="#999999" class="style4" scope="row"><h4><span class="style1"></span><span class="style1"></span><span class="style1"><strong>Professional: The faculty member role modeled and promoted the values of</strong></span></h4></th>
		    <td bgcolor="#FFFFFF" class="navText">(18) The highest levels of integrity and honesty </td>
		    <td>%h_p_1%</td>
		    <td>%a_p_1%</td>
		    <td>%l_p_1%</td>
		  </tr>
		  <tr>
		    <td bgcolor="#FFFFFF" class="navText">(19) Sensitivity to and respect for diversity </td>
		    <td>%h_p_2%</td>
		    <td>%a_p_2%</td>
		    <td>%l_p_2%</td>
		  </tr>
		  <tr>
		    <td bgcolor="#FFFFFF" class="navText">(20) Understanding and application of the principles of medical ethics to clinical situations</td>
		    <td>%h_p_3%</td>
		    <td>%a_p_3%</td>
		    <td>%l_p_3%</td>
		  </tr>
		  <tr>
		    <th bgcolor="#999999" class="style4" scope="row"><h4><span class="style1"></span></h4></th>
		    <td><strong>
		      <label>(21) How would you rate this faculty member as a role model?</label>
		    </strong></td>
		    <td>%h_r_1%</td>
		    <td>%a_r_1%</td>
		    <td>%l_r_1%</td>
		  </tr>
		  <tr>
		    <td colspan="5" scope="row">
		      <strong>
		      <label>Comments by Individual Students:<br></label>
		      </strong>
		      %comments%
		    </td>
		  </tr>
		  <tr>
		    <td colspan="5" scope="row">
		      %graph%
		    </td>
		  </tr>
		  <tr>
		    <td colspan="5" scope="row"><div align="center"><span class="style6">Report compiled by Rukhshanda Zaman, Coordinator Health Professions' Education. Shifa College of Medicine.</span></div></td>
		  </tr>
		</table>
	</body>
</html>
